Journal of Clinical and Aesthetic Dermatology

APR 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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42 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2018 • Volume 11 • Number 4 R E V I E W DISCUSSION Psoriasis, lupus, and lichen planus were found to be the most commonly reported inflammatory skin conditions with respect to dermoscopy. Sensitivity and specificity data were reported for psoriasis, but not for lichen planus or lupus. However, unique features of lupus and lichen planus have been repeatedly reported. For plaque psoriasis, the combination of regularly distributed dotted vessels with a light red background and diffuse white scales was reported to be 88.0-percent specific and 84.9-percent sensitive. 6 Another study looking at how to differentiate basal cell carcinoma from psoriasis showed that there was a 99-percent diagnostic probability that the lesion was psoriasis if it had a homogeneous vascular pattern, red dots, and a light red background. 7 The highly specific and sensitive dermoscopic findings of psoriasis are very helpful when differentiating psoriasis from basal cell carcinoma. 7–10 In contrast to the aforementioned dermoscopic findings of psoriasis, basal cell carcinoma has the following characteristics under dermoscopy: shiny white structures, ulceration, blue-gray ovoid nests, spoke wheel-like structures, and arborizing vessels. 10 While the clinical distinction between the two diagnoses is sometimes difficult, their respective dermoscopic findings are quite different. Appropriate treatment is dependent upon accurate diagnosis. Furthermore, if basal cell carcinoma is detected in a patient with psoriasis, treatment modalities such as ultraviolet light or tumor necrosis factor-alpha inhibitors might need to be adjusted or discontinued. Therefore, in a patient with psoriasis, new scaly pink patches are best analyzed with dermoscopy to determine if the patches are a manifestation of psoriasis or a new basal cell carcinoma. Dermoscopy is also potentially useful in expediting care for those with inflammatory skin conditions. For example, patients with psoriatic arthritis sometimes have subtle or minimal skin disease. Dermoscopy might support a diagnosis of psoriasis instead of a different inflammatory condition. Additionally, dermoscopy might prove to be useful in the diagnosis of discoid lupus. The dermoscopic findings of discoid lupus on the scalp have been repeatedly reported. If the clinical morphology and dermoscopy findings are consistent with discoid lupus, there might not be a need for skin biopsy. Thus, dermoscopy has the potential to expedite the initiation of therapies. If more is published on the sensitivity and specificity of the dermoscopic findings of psoriasis, lichen planus, and lupus, fewer biopsies might be needed to obtain accurate diagnoses. As a result, dermoscopy can potentially reduce risk to the patient, expedite treatment, and lower medical costs. CONCLUSION Dermoscopy has been widely studied in differentiating benign and malignant skin lesions and is now expanding its role as a tool for the evaluation of inflammatory skin conditions. Lallas et al 3 reported the wide range of inflammatory and infectious conditions in which dermoscopy has the potential to be helpful. We found many reports on the use of dermoscopy in psoriasis, lupus, and lichen planus, but were unable to appraise the quality of these findings due to the paucity of rigorous studies. The lack of original research on this topic makes it difficult to move forward with evidence-based recommendations for the use of dermoscopy in identifying inflammatory conditions, despite a plethora of unique findings on the use of dermoscopy for each condition. In order for the benefits of dermoscopy in the evaluation of rashes to be validated, reports on the sensitivity and specificity of dermoscopic findings for inflammatory conditions other than psoriasis are necessary. REFERENCES 1. Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol. 2002;3(3): 159–165. 2. Vestergaard M, Macaskill P, Holt P, Menzies S. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159(3):669–676. 3. Lallas A, Giacomel J, Argenziano G, et al. Dermoscopy in general dermatology: practical tips for the clinician. Br J Dermatol. 2014;170(3):514–526. 4. Bolognia J, Jorizzo J, Schaffer J, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012. 5. Plaza J, Prieto V. Inflammatory Skin Disorders. 1st ed. New York, NY: Demos Medical; 2012. 6. Lallas A, Kyrgidis A, Tzellos TG, et al. Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea. Br J Dermatol. 2012;166(6):1198–1205. 7. Pan Y, Chamberlain A, Bailey M, et al. Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque–features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis. J Am Acad Dermatol. 2008;59(2):268–274. 8. Menzies S, Westerhoff K, Rabinovitz H, et al. Surface microscopy of pigmented basal cell carcinoma. Arch Dermatol. 2000;136(8):1012–1016. 9. Altamura D, Menzies S, Argenziano G, et al. Dermatoscopy of basal cell carcinoma: morphologic variability of global and local features and accuracy of diagnosis. J Am Acad Dermatol. 2010;62(1):67–75. 10. Marghoob A, Malvehy J, Braun R, eds. An Atlas of Dermoscopy. 2nd ed. Boca Raton, FL: CRC Press; 2012. JCAD FIGURE 1. Light pink/red background, red dots, and white scale shown in dermoscopy of psoriasis FIGURE 2. Dermoscopy of discoid lupus. The solid arrow shows a follicular keratotic plug, while the dashed arrow shows peri-follicular scale. FIGURE 3. Dermoscopy of lichen planus. The arrow notes rounded pearly white structures.

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